Help! Hospice now vs. continued acute care experience for fairly new grad ('00)

  1. My current dilemma is causing me great anguish and sleeplessness. If anyone has any feedback, I'd really appreciate it.

    I'm a 29 year-old R.N. with a B.A. in religious studies ('96) and a B.S.N. ('00). The last year and a half I worked on an med-surg/oncology in central Virginia for a small not-for-profit community hospital in central Virginia. In that position, I often took care of hospice patients and LOVED the experience. However, one of my greatest frustrations was having a mixed assignment consisting of, say, one or two hospice patients and three to four agressive care folks. The menial multiple task mastering that the latter group required always seemed to take precedence over the more amorphous spiritual and psychosocial care that hospice patients require. Bottom line: Next time I work with hospice patients, I want to work with just hospice patients for that particular shift.

    Now, I just relocated to my parents' house in the N. Va. area to try to save money with which to afford a house down payment. I was just offered a FT position at an acute care inpatient hospice house at $21/hr. I was also just offered a FT position in telemetry at Georgetown at $23/hr plus a big sign-on bonus. I know I love, love, love, love hospice and find hospital inpatient treatment stressful and creatively tedius. Nevertheless, I'm tempted to take the Georgetown job for the following reasons: Experience, flexibility, and income. Here's why:

    Some nurses have said that as the hospice field grows it will begin to encompass a wider variety of med-surg type cases. I recently even heard of an available Robert Wood Johnson grant to study the feasability of extending hospice and palliative care to ICU settings. A hospice nurse educator in the Charlottesville area is a psychiatric CNS, but she also works one day a week at U.Va.'s CCU and says she will "for the rest of her life" because it will keep her acute care skills current, which she finds very pertinent to her value as a hospice nurse.

    Also, since hospice pays relatively less than inpatient fields (around here the FT salary cap is at around $60,000 after 15 years, barely enough on which to live inside the Capitol Beltway if you're single, like me) having up-to-date med-surg skills means being able to either moonlight or split my time 50-50 between hospice and better-paying inpatient work if I ever find myself cash-strapped. Within the N. Va. hospice organization the only advanced practice and therefore high-paying nursing positions are in management (unsure if that's for me) and staff training (which may be for me). The only problem with the prospect of becoming a staff trainer is that the N.Va. organization only employs two of them for an area consisting of 5 counties, so I imagine that competition for the positions is quite keen if they ever become open.

    Sorry this was so long, but my situation and thinking is complicated and conflicted, and I need to make a decision soon. Thanks ahead of time for any feedback.
    Last edit by Woodchuck on Jan 7, '03
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  2. 8 Comments

  3. by   renerian
    I am sorry go with your heart and it sounds like it is in hospice. JMHO

    renerian
  4. by   aimeee
    Just three words from the late Joseph Campbell. Follow your bliss.
  5. by   Woodchuck
    Thanks for your input. Joseph Campbell's a treasure. I just rewatched one of his last interviews with Bill Maher on PBS last month.

    My Dad agrees with the both of you, maintaining that folks typically only excell at work they truly love, although my mother advises the more practical route.

    All I know is that after working with hospice patients at my last job, I'd always go home feeling as if I knew myself a little bit better for the experience, and self-knowledge is certainly an honorable alternative way of getting rich quick.

    If either of you have in-hospital med-surg experience, how did you enjoy that compared to your current work now? How frequently do you receive in-service training, and what kind of content does it typically cover? Do your hospice organizations at all employ master's prepared nurses for their advance practice skills?

    Thanks again for your feedback!
  6. by   2banurse
    I would suggest that you work where you will be most happy (i.e. hospice care). Maybe you can even work per diem or with an agency occasionally to help you financially.

    Best of luck!
    Kris
  7. by   aimeee
    Sorry, no acute care experience here (mine is in LTC), and we don't have any in-patient hospice in our county either. Think about what you enjoy doing the most, what is most rewarding to you, and figure out which position will provide you with more opportunity to do more of it.
  8. by   fab4fan
    If you really love hospice nursing, then I think that's what you should do. You gave some good reasons for taking the tele job, but not one was enough to make me think that's what you should do.

    I agree...you excell doing what you love. Don't be too worried about that far into the future; who knows what's going to happed 5, 10, 15+ years from now. We don't even know what tomorrow will bring. Don't be in a position which will make you look back with regret.

    As far as skills go; I worked M/S and hospice, and I actually got more skill wise in hospice than M/S. Just my experience.

    It sounds like hospice is your calling (corny, I know)...do it!
  9. by   Constance Ann
    Woodchuck, by now you have probably chipped away at this problem and came up with a solution. Being an older new RN I recommend that you do what makes you happy but be wise when wanting to create debt for yourself. An investment of a house is a good idea, but will you always want to live in the area you are in now? My husband and I have had to make some drastic changes when life took an unusual turn for us. He became ill and unable to work. We had lots of toys and a nice home. When he became ill we had to get rid of our toys to survive. When I look back on it I wish we had not had so many toys and I am not saying this about your house. What I am trying to say is, it is surprising how little it takes to live on when you are happy. I cherish each day with my husband and there are no frills, but then I have already had the toys so maybe you will have to find this out for yourself. I think working in hospice gives you the perspective of how uncertain life is and to live each day to the fullest. The one advantage you have is you are wise in asking questions and you have your youth and can make changes if you need to. Myself I have to establish myself so that I may be able to retire in a few years with some compensation. Good luck W
  10. by   LLDPaRN
    Woodchuck
    Like the others, I say go with the hospice, and see if Georgetown has a per diem or casual position available (chances are they do, and would be glad to get any help they can!). Obviously you really enjoy working with hospice patients (It is rewarding, I did it myself for a short time. Left b/c I didn't like traveling into not so nice areas of Philly, not b/c I didn't like the patients themselves). Anyway, good luck to you and feel free to send me a PM if you have any questions

    Laurie

    Newly minted MSN

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